慢性阻塞性肺病病人的六分鐘行走測試：呼氣末正壓呼吸對呼吸困難的影響

Six-Minute Walk Test in Patients with Moderate to Severe COPD: The Effect of Positive End Expiratory Pressure Breathing on Dyspnea

黃千惠(Chien-Hui Huang) ； 李志偉(Chih-Wei Lee) ； 謝文億(Wen-Yih Hsieh) ； 黃敬偉(Chin-Wei Wong) ； 楊治國(Gee-Gwo Yang)

《物理治療》 30卷5期 (2005/10) Pp. 199-206

摘要

背景與目的：高換氣需求時，阻力使氣道阻塞的病人呼氣更形困難。呼氣末正壓呼吸緩解運動時動態壓迫，減少吸氣肌做功，因而減輕呼吸困難。本研究以慢性阻塞性肺病病人為對象，比較呼氣末正壓呼吸與一般正常呼吸對六分鐘行走後呼吸困難程度改善。方法：25位可行走的慢性阻塞性肺病病人(FEV1=37.6±9.8% predicted)完成兩次六分鐘行走測試，走後隨機給予10 cmH2O正壓呼吸器與一外觀相同但不具正壓的呼吸器，要求病人做10個呼吸。在走前及走後、走後2分鐘、走後5分鐘、走後10分鐘以修正式柏格式量表詢問其呼吸困難程度。結果：兩次六分鐘行走距離無差異。重複量數雙因子變異數分析顯示，六分鐘行走後呼吸困難程度上升。然而，10個10 cmH2O正壓呼吸對於六分鐘行走後呼吸困難程度改善，與一般呼吸並無顯著差異。相較於國外資料，病人具較低的最大吸氣壓，顯示吸氣肌力較弱。結論：呼吸困難的原因眾多，10個10 cmH2O外接式正壓呼吸對六分鐘行走後的呼吸困難緩解，與一般呼吸相較，不具直接效果。

關鍵字

等壓點 ； 最大吸氣壓 ； 內部呼氣末期正壓 ； 圓唇式吐氣 ； 修正式柏格量表

並列摘要

Background of Purpose: Dynamic hyperinflation and the development of intrinsic positive end-expiratory positive pressure (PEEPi) are commonly observed post exercise in chronic obstructive pulmonary disease (COPD)patients. An external positive end-expiration pressure can counterbalance the inspiratory threshold load imposed by PEEPi and therefore may reduce the work of breathing and dyspnea. The purpose of this study was to investigate effect of PEEP breathing on dyspnea after a six-minute walk test. Methods: Twenty-five ambulatory COPD patients (FEV1=37.6±9.8% predicted) finished two six-minute walk tests. Subjects were randomly given a 10 cmH2O pressure relief valve after one of the walks and asked to take 10 breaths. For the other walk, subjects were given a valve with the same appearance with no pressure on it. Subjects were asked to evaluate their level of dyspnea using Modified Borg Scale before and after the walks. Results: Two way repeated ANOVA showed their dyspnea level significantly increased after the walk and continued elevated for 5 minutes. However, when compared to normal breathing, ten PEEP breaths did not have a positive effect on dyspnea. Maximal inspiratory pressure (MIP) measured in the current study was lower than age-matched data found overseas and probably accounted for dyspnea. Conclusion: There are different mechanisms that cause dyspnea. Ten PEEP breaths at 10 cmH2O did not relieve the dyspnea induced by six-minute walk tests.

並列關鍵字

Equal pressure point ； Maximal inspiratory pressure ； Intrinsic positive end-expiratory pressure ； Pursed-lip breathing ； Modified Borg Scale